[HSF] Another on vs off pump question, dilatation of IMA......

[Mitch Lirtzman]

For what it's worth...granted!At 09:06 AM 6/12/2007, you wrote:
>Thanks Mitch .... that was very kind of you ..... permission to use the
>expression .... !
>
>NFA
>
>
>On 6/7/07, Mitch Lirtzman <drmitch at cox.net> wrote:
>>
>>Bright Red Blood. Immediately prior to anastomosis, I let the LIMA bleed
>>freely..."BRB across the table"At 02:54 AM 6/7/2007, you wrote:
>> >"BRB across the table"
>> >What is BRB ?
>> >
>> >NFA
>> >
>> >On 6/6/07, Mitch Lirtzman <drmitch at cox.net> wrote:
>> >>
>> >>John, I would respectfully disagree with part of the last posting. As
>>one
>> >>of the "wrappers and extraluminal injectors", in well over two decades,
>> >>dark blood has never come out of the LIMA at the time of unclamping for
>> >>grafting. I'm one of the leave-it-on-the-pedicle guys with accompanying
>> >>veins. As stated, I don't skeletonize and have never had problems with
>> >>graft length. My guess is that the vasa vasorum remain intact...or
>> >>whatever
>> >>circulation others have postulated, and the vessel remains a living
>>organ.
>> >>BRB across the table.
>> >>Mitch LirtzmanAt 08:45 PM 6/6/2007, you wrote:
>> >> >Don, you and others have said that you clamp and divide the IMA and
>>lay
>> >>it
>> >> >aside until time for the anastomosis, some with it wrapped in a sponge
>> >> >soaked
>> >> >with papaverine and/or verapamil, some after injecting the same drugs
>> >>into
>> >> >the
>> >> >  lumen, and later found the IMA to be plump and pulsating. Perhaps
>>there
>> >>is
>> >> >another explanation. When you open the IMA after it has been clamped
>>for
>> >> >some
>> >> >time, the blood in the lumen is dark, desaturated, meaning that the
>> >>oxygen
>> >> >has  been extracted, which must mean that the vessel wall has been
>> >>ischemic.
>> >> >Could it  be that when the smooth muscle cells become ischemic, they
>>lose
>> >> >there
>> >> >capacity  to contract and the vessel wall relaxes and dilates and the
>> >>drugs
>> >> >have nothing  to do with it? John Flege
>> >> >
>> >> >
>> >> >
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>> >Nasser  F.  Abou'Seada,
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>--
>Nasser  F.  Abou'Seada,
>MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
>FICS,FISCVS,FSSRCTS,FHMS,MESC
>_______________________________________________
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